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  Characteristics, Policies, and Practices of Clinical Ethics Fellowship Programs

  Amanda Bachand, Ellen Fox, and Jason Adam Wasserman

  Publication Date: 5-2025

  • While clinical ethics fellowship programs are now commonplace in U.S. hospitals, recent research has revealed significant problems including a shortage of personnel who are appropriately trained to perform ethics consultation, lack of access to high quality training for ethics consultants, and lack of funding for clinical ethics training.1

  • Our goal was to accurately describe the characteristics, policies, and practices of existing clinical ethics fellowship programs in the U.S. and Canada as well as the opinions of clinical ethics fellowship program directors regarding program standards, accreditation, and funding through a robust questionnaire.

  • This project focused specifically on the development of a cognitive interviewing protocol designed to refine the questionnaire that would be used to measure core constructs of fellowship programs.

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  Veracity Enhancement Using Non-Invasive Brain Stimulation: A Systematic Review

  Alice Hou, Shahrukh Naseer, and Abram Brummett

  Publication Date: 5-2025

  For decades, non-invasive brain stimulation (NIBS) techniques like Transcranial Magnetic Stimulation (TMS) and Transcranial directcurrent stimulation (tDCS) have been used in clinical settings as forms of neuromodulatory treatment for depression and other neurodivergent disorders. In recent years, there has been increased research in utilizing the non-invasive techniques to enhance cognition beyond one’s baseline, including language, memory, moral, and veracity enhancements. Due to the lack of systematic reviews in the growing field of veracity enhancement, we aim to provide a concise, summative overview of current research studying the impacts of NIBS on truthfulness, as well as its ethical dilemmas and future directions.

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  Exploring Spirituality Rounds: A Reflective Inquiry Among Chaplains and Medical Students

  Jessica Krone and Kevin Hickey

  Publication Date: 5-2025

  • Medical schools aim to educate their students on about social factors that impact patient health, including spirituality.
  • Medical school curriculums have various approaches to spiritual care education, with some using modules and others using inperson experiences. 1,2.
  • “Spirituality Rounds”, a half-day experience for third year medical students, is a component of OUWB’s curriculum that allows students to shadow and learn from hospital chaplains.
  • This experience has not yet been evaluated; therefore, this research will gather student and chaplain reflections to help determine if this is a beneficial experience, and if it should be recommended to be included in medical education curriculum at other institutions.

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  Changes in Medical Student’s Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

  Nicholas Ludka, Abram Brummett, and Jason Adam Wasserman

  Publication Date: 5-2025

  The pluralism of views that surround death, both within the bioethics community and society as a whole, can be a source of frustration for medical students and physicians who encounter surrogate decision makers who deny the standard medicolegal view of death. There are large gaps in knowledge regarding brain death among medical students, likely due to the lack of educational initiatives and the reliance of media for information, which often portrays inaccurate descriptions of brain death. 1 Despite the growing literature on the inadequacy of medical students’ knowledge of brain death, there has yet to be investigation into students’ attitudes toward brain death and other, non-standard views of death. 2 Therefore, we developed a lecture with an accompanying questionnaire to determine students’ knowledge and attitudes for different views of death.

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  End-of-Life Volunteerism: An Analysis of No One Dies Alone (NODA) Program Volunteers

  Kristin Sarsfield and Kevin Hickey

  Publication Date: 5-2025

  The inception of hospice in the United Kingdom during the mid 20th century marked a focal point in medical care for dying individuals. Hospice founder Cicely Saunders wanted to maintain a balance of “the sophisticated science of our treatments with the art of our caring, bringing competence alongside compassion”.1 Since then, hospice has grown into a household term for end of-life medical care.

  Organized care for terminally ill and dying individuals was further developed in 2001 by Sandra Clarke, CCRN. Clarke founded the No One Dies Alone (NODA) Program after being unable to fulfill a dying patient’s wish of end-of-life companionship.2 The NODA Program prepares volunteers to spend time at bedside with dying patients who are alone for whatever reason. In 2014, Corewell Health William Beaumont University Hospital (CHWBUH; formerly Beaumont Royal Oak) implemented its chapter of NODA that was later redesigned in 2019.

  End-of-life care is a sensitive subject that can provoke feelings of fear and sadness. Thus, individuals wanting to volunteer in this setting must have specific qualities or experiences that drive their desire to spend time with dying hospice patients. The main goal of this project is to learn more about the personal motivating factors and cohort details of NODA volunteers at CHWBUH.

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  A Survey of factors Affecting Students Ethical Attitude toward Medical Disobedience

  Quinn Simpson and Jason Adam Wasserman

  Publication Date: 5-2025

  • Government regulations, particularly post-Roe v. Wade, create ethical conflicts for physicians between patient care and legal constraints.¹
  • Decisions influenced by external pressures can negatively affect patient health.¹

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  Examining the Spiritual Care Needs of Patients Preceding In-Hospital Death

  Kevin A. Van and Kevin Hickey

  Publication Date: 5-2025

  - Evaluating the spiritual care needs of dying patients within the hospital setting is not a well-developed area of research

  - Patients who die within the hospital present varied spiritual and emotional needs that require an array of support strategies from a spiritual care (SC) standpoint

  - There is insufficient quantifiable data on specific patient needs and interventions provided through SC, especially among end-of-life (EOL) patients

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  Prevalence of traumatic brain injury among the guests at a low-barrier homeless shelter

  Nicholas Ang and Jason Wasserman

  Publication Date: 5-2024

  Traumatic Brain Injury (TBI) is a significant public health concern, characterized by disruption of normal brain function due to head trauma, with common causes including automobile accidents, athletic injuries, and assault. TBI accounts for a substantial portion of injury-related deaths worldwide and is a leading cause of neurological disability. However, there's considerable variability in defining and measuring TBI, complicating prevalence comparisons. Studies indicate varying rates, with a particularly high prevalence among individuals experiencing homelessness, potentially due to increased vulnerability to trauma. The cognitive impairments associated with TBI, often manifesting years later, pose challenges, especially for marginalized populations like the homeless, who may face barriers to treatment and social integration. The relationship between TBI and homelessness is complex, with evidence suggesting bidirectional causality. Despite this, research on TBI within specific homeless subpopulations, such as those utilizing low-barrier shelters, remains limited. This study aims to address this gap by examining TBI prevalence among clients of a low-barrier homeless shelter and investigating the temporal relationship between TBI and homelessness.

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  Cancer Screening Guidelines in Midwest Adult Correctional Facilities

  Stephen Greenwell and Jason Adam Wasserman

  Publication Date: 5-2024

  National cancer screening guidelines (CSGs) exist to promote early cancer detection, reducing mortality, morbidity, and cost. The incarcerated population is at increased risk for certain cancers, decreased cancer screening, and barriers to treatment. In this study we investigate how state and federal prison CSGs differ from the National Comprehensive Cancer Network’s (NCCN) CSGs.

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  Impact of Housing First Supportive Housing Provision on Healthcare Accessibility and Health Status of Individuals who Previously Experienced Homelessness

  Aubrey Haughn, Tiffany Loh, and Jason Adam Wasserman

  Publication Date: 5-2024

  • The 2020 AHAR report to Congress revealed about 580,000 people experience homelessness on a single night.
  • Approximately 3 out of every 200 people have experienced homelessness.
  • Individuals experiencing homelessness face higher risks of infectious diseases, injuries, mental health issues, substance abuse, and suicide.
  • Individuals experiencing homelessness are 6-10 times more likely to have unmet healthcare needs compared to the general population.
  • In contrast to a treatment-first approach, the housing first (HF) approach of supportive housing focuses on provision of immediate stable housing for individuals experiencing homelessness without preconditions regarding substance use.
  • Avalon House Hickory Way are newly implemented HF apartments based in Ann Arbor, Michigan.

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  Critical Reflection and Place Based Medical Education in Bioethics, Humanism, and Professional Identity Formation: The Impact of a Study Trip to Auschwitz

  Maxwell Li, Ramona Stamatin, Hedy Wald, and Jason Wasserman

  Publication Date: 5-2024

  Between 1939 - 1945, unethical and often ghastly human experimentation was conducted in Nazi concentration camps. Physicians working in the camps also performed selections of prisoners for work detail or immediate death. Ultimately, there was a significant amount of physician complicity in Nazism and the Holocaust, ie. the genocide of European Jewry. At the end of WWII, war crime trials against the doctors and scientists involved helped give rise to the Nuremberg Code of Ethics.

  There are increasing calls for inclusion of education on medicine during the Holocaust in medical school curricula. A study trip to Poland with pre-trip study modules for medical students was conducted examining the role of physicians during the Holocaust as an extension of medical ethics and humanities curriculum at the Oakland University William Beaumont School of Medicine (OUWB). Students were prompted about their experiences.

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  Perspectives of a permanent supportive housing population on their trust in sources of health information, experiences with health care providers, and navigation of health information amidst the COVID-19 pandemic

  Tiffany Loh and Jason Wasserman

  Publication Date: 5-2024

  Permanent supportive housing (PSH) has become the predominant housing intervention for addressing homelessness in the U.S.1 It provides o Unhoused adults with mental and substance use disorders long-term, affordable housing2 o Voluntary social support services.

  Studies have found that the unhoused population experience mistreatment in health settings.3–6 o Some unhoused individuals expressed not being seen as human, feeling invisible to health providers, or treated as an experiment.

  Limited research on sources of health information used by those who have experienced homelessness. o Allen et al. found that unhoused individuals refer to news media, word of mouth, the internet and social media, as their main sources of health information.7 o In a survey conducted during the COVID pandemic, respondents in homeless shelters in Detroit, MI placed most trust in vaccine information from the news.

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  Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscientious Provision

  Marlee Mason-Maready, Victoria Whiting, and Abram Brummett

  Publication Date: 5-2024

  Some Catholic hospitals provide emergency contraception (EC) to rape victims, but some prohibit it based on institutional conscience and that it may act as an abortifacient.

  We argue that the reasonable internal disagreement on this issue can be the basis for Catholic hospitals to accommodate physicians who may feel compelled by conscience to provide EC.

  U.S. legal asymmetries protect conscientious objection (CO) in health care, but not conscientious provision (CP). Catholic hospitals can sanction or even fire physicians who provide EC.1, 2.

  Ramifications of barriers to EC access and potential objections to this perspective are also discussed.

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  Relationships between the Number of Chaplain Visits and Patient Characteristics at a Large, Midwestern Suburban Teaching Hospital

  Sarah E. Toates and Kevin D. Hickey

  Publication Date: 5-2024

  Hospital-based chaplaincy increases patient satisfaction and overall quality of life1 and has been shown to positively influence physical and mental health outcomes.2 Given that most inpatient chaplaincy departments operate with limited staff and resources, and that the vast majority (83%) of patients wish to discuss religion and spirituality with their health care team,3 understanding the activities of inpatient chaplains is essential to optimize the care chaplains provide to hospitalized patients. In general, the current medical literature lacks data to guide inpatient chaplains’ activities based on patient characteristics,4 thus, there is a need for an empirical evaluation of spiritual care departments’ activities in order to demonstrate value, promote quality improvement, and enhance care.

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  Exploring Illness Beyond Disease: Development of a sense of identity in patients with inflammatory bowel disease (IBD)

  Nicholas Totah and Jason Adam Wasserman

  Publication Date: 5-2024

  • Inflammatory bowel disease (IBD) poses significant challenges to an individual’s physical and emotional well-being, often reshaping their sense of self and life trajectories.
  • Patient narrative can illuminate the illness experience in ways that are often unaddressed in the literature.

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  What Exactly is a Patient's Best Interest

  Saketh Akula, Joshua Jones, Jason Wasserman, Mark C. Navin, and Abram Brummett

  Publication Date: 5-2023

  In any clinical setting, the patient’s preferences are respected and valued by the medical team. As clear as that may seem, that can be tough when considering all the perspectives of what makes up a patient’s best interest (BI), especially for a minor. In the literature, there is wide disagreement about the interpretation of BI. The primary goal of this project is to unearth the perspectives that play into a pediatric patient’s best interest and delineate how and whether family interests should be considered.

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  Conceptualization of Effective Surrogate Decision Making

  Zachary Armstrong, Michael Bourgoin, Abram Brummett, Jason Wasserman, Mark C. Navin, and Stephanie Swanberg

  Publication Date: 5-2023

  Surrogate decision making is a key component in the hierarchy of medical decisions, whereby an assigned individual makes choices on behalf of a patient incapable of making the decision themselves. Although this is common in healthcare, there are still many questions about best surrogate practices and ethical credibility. This capstone project aspires to map these concepts and discuss issues related to the current landscape of surrogate decision making with regards to medical ethics through the use of a systematic literature review.

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  Differences in Rational and Relational Autonomy during End-of-Life Care

  Michael Balce, Mark C. Navin, Abram Brummett, and Jason Wasserman

  Publication Date: 5-2023

  Within biomedical ethics, the principle of autonomy focuses on a patient’s right to make choices about his or her medical decisions and care. Along these lines, patients can then make decisions based on their own beliefs, attitudes, and customs, which is referred to as rational autonomy. However, shared-decision making is often more complicated than this, and patients often desire input from their spouse, family, and other trusted individuals, which is termed relational autonomy. These two concepts of autonomy drive different approaches to an individual’s perceptions and choices regarding medical-decision making during the end of one’s life.

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  Conceptualization of Evidence Used by Surrogate Decision-Makers to Determine a Patient’s Wishes

  Michael Bourgoin, Zach Armstrong, Abram Brummett, Mark C. Navin, Jason Wasserman, and Stephanie Swanberg

  Publication Date: 5-2023

  Many modern concepts within clinical bioethics can be conceptualized in various ways. This subjectivity is demonstrated when analyzing ideas in the literature about the types of evidence that can or should be used by surrogate decision-makers to determine a patient’s wishes. This project aims to explore normative claims on this topic in order to map out the current landscape of the various understandings of this concept.

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  Medical Student Knowledge of Physician Involvement in the Holocaust and the Importance of Incorporating Holocaust Studies and Ethics into Medical School Curricula

  Megan Bricely and Jason Wasserman

  Publication Date: 5-2023

  A 2019 Claims Conference study demonstrated an alarming lack of knowledge about the Holocaust in the United States general population. There is currently no specific data on medical student knowledge of the Holocaust and the role that the medical community played. The goal of this study was to gather baseline data on medical student knowledge of the Holocaust and medicine’s involvement to demonstrate the need for Holocaust teaching in medical school.

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  The Ethics of Medical Interventions Against Parental Consent

  Corey Carney, Mark C. Navin, Jason Wasserman, Abram Brummett, and Kaitlyn Hanson

  Publication Date: 5-2023

  Between an adult patient and physician they are the only two people that have a say in the patient’s medical treatment with the patient having the final say. In pediatrics, there is a patient, parent, and physician which adds a third party that is a proxy decision maker for the child but lacks absolute authority over the child’s treatment. The goal of this study is to give a sense of the diversity of the pediatric ethics literature regarding parent/physician disagreements and to address ambiguities about pediatric interventions.

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  Self-Triage Among Patients Who Are Homeless

  Jimmy Clemmens and Jason Wasserman

  Publication Date: 5-2023

  People who are homeless present to urban emergency departments at a higher rate per 1000 people than those who are housed.1 With those added difficulties, people who are homeless frequently turn to Emergency Departments for primary, rather than only emergency, health care treatment.2,3 There is great need for investigation into the thought process for the self-triage of the patient who is homeless. This study was undertaken to survey adults at HOPE adult shelter about their ability to determine the most appropriate place to seek treatment for different common conditions of varying acuity, as well as to evaluate the efficacy of an educational resource used to help identify where appropriate medical treatment can be sought.

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  Concern for Authenticity in Rational and Relational Autonomy

  Joshua J. Daniel, Abram Brummett, Mark C. Navin, and Jason A. Wasserman

  Publication Date: 5-2023

  The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether a trend exists for the inclusion of authenticity in rational or relational autonomy. A secondary goal is to determine whether a trend exists with the use of autonomy and the highest degree of the authors.

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  Conceptualization of Intervention in Pediatrics Systematic Review

  Kaitlyn Hansen, Mark C. Navin, Jason Wasserman, and Stephanie Swanberg

  Publication Date: 5-2023

  Navigating when to intervene against parents’ wishes is a difficult task in pediatrics. Different frameworks have been proposed, but disagreements remain. One problem debated about in pediatric intervention principles often refer to different kinds of interventions (e.g. calling Child Protective Services, consulting the Ethics Committee). This project reports results of a critical scoping review of recent bioethics literature about the concept of pediatric intervention principles.

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  'Best Interest' in Clinical Medicine: A Critical Scoping Review

  Joshua R. Jones, Saketh Akula, Jason Wasserman, and Mark Navin

  Publication Date: 5-2023

  The Best Interest Standard (BIS) has been a much-debated guidance principle in clinical ethics with ambiguous definition and application. In this study we focus on the conceptions of best interests that differ according to which kinds of interests are included. While there is wide agreement that ‘best interests’ include the physiological welfare of a patient, there is still substantial disagreement about which other interests are included in wider accounts of welfare, the balancing of those other interests, and whether interests are objective or subjective.